MEMBERSHIP APPLICATION

Lodge ATV Club
PO Box 166
Depauville, NY 13632

  E-Mail: rkilmer_69@hotmail.com          Website: lodgeatvclub.20m.com

Name: _________________________________________________

Address: _______________________________________________

City, State, & Zip Code: ___________________________

Telephone #: ___________________________________________

Email Address: _______________________________________

Type of ATV: ___________________________________

Type of Membership

Single - $10/year (# of People) ___________

Waiver:

I, the undersigned, waive all rights from accident or injury while participating in any event sponsored by the Lodge ATV Club. I fully understand that the sport of ATV riding is dangerous, and involves the risk of injury or death. All members must follow DMV, DEC, Local and State Laws. I will not file suite against the Lodge ATV Club, it's Officers, Board of Directors/Members or any landowner where, on or near designated trails, rides or facilities are located.

Signature: ______________________Date: _____________

Parent/ Guardian Signature: __________________________

(Required if individual seeking membership is under the age of 18 years old.)